Retrospective Analysis of Thoracoscopic Surgery for Esophageal Submucosal Tumors

Abstract

BackgroundSurgical enucleation is the treatment of choice for esophageal submucosal tumors (SMTs) with symptomatic, larger, or ill-defined lesions. The enucleation of SMTs has traditionally been performed via thoracotomy. However, minimally invasive approaches have recently been introduced and successfully applied. In this study, we present our experiences with the thoracotomic and thoracoscopic approaches to treating SMTs.MethodsWe retrospectively reviewed 53 patients with SMTs who underwent surgical enucleation between August 1996 and July 2013. Demographic and clinical features, tumor-related factors, the surgical approach, and outcomes were analyzed.ResultsThere were 36 males (67.9%) and 17 females (32.1%); the mean age was 49.2±11.8 years (range, 16 to 79 years). Histology revealed leiomyoma in 51 patients, a gastrointestinal stromal tumor in one patient, and schwannoma in one patient. Eighteen patients (34.0%) were symptomatic. Fourteen patients underwent a planned thoracotomic enucleation. Of the 39 patients for whom a thoracoscopic approach was planned, six patients required conversion to thoracotomy because of overly small tumors or poor visualization in five patients and accidental mucosal injury in one patient. No mortality or major postoperative complications occurred. Compared to thoracotomy, the thoracoscopic approach had a slightly shorter operation time, but this difference was not statistically significant (120.0±45.6 minutes vs. 161.5±71.1 minutes, p=0.08). A significant difference was found in the length of the hospital stay (9.0±3.2 days vs. 16.5±5.4 days, p<0.001).ConclusionThe thoracoscopic enucleation of submucosal esophageal tumors is safe and is associated with a shorter length of hospital stay compared to thoracotomic approaches.

Combined thoracoscopic and endoscopic surgery for a large esophageal schwannoma

“…Esophageal SMTs constitute less than 1% of all esophageal tumors. The most common among them are leiomyomas, with esophageal schwannomas accounting for 2%-3.4% of all esophageal SMTs[ 5 , 13 ]. Enucleation is considered as the treatment of choice for benign tumors that are symptomatic or rapidly increasing in size[ 1 ].…”

“…Although, the left thoracic approach may provide direct access to a tumor on the left esophageal wall, the aortic arch and the trachea may restrict this access, especially for tumors located in the upper and middle thoracic esophagus. The left thoracic approach is usually applied for tumors located in the lower thoracic esophagus or at the esophagogastric junction[ 13 , 14 ].…”

Video-Assisted Thoracic Surgery vs. Thoracotomy for the Treatment in Patients With Esophageal Leiomyoma: A Systematic Review and Meta-Analysis

“…Under normal circumstances, the treatment of these benign esophageal tumors can be removed by surgery. The indications for surgery are large or symptomatic tumors, or tumors that show a growing trend after a period of observation ( 4 ). Traditionally, surgical resection is performed through an open method.…”

“…(1) Representativeness of the exposed cohort, (2) selection of the non-exposed cohort, (3) ascertainment of exposure,(4) demonstration that outcome of interest was not present at the start of the study, (5) assessment of outcome,(6) was follow-up long enough for outcomes to occur,(7) adequacy of follow-up.…”

Simultaneous resections of left lung cancer and esophageal schwannoma using video‐assisted thoracoscopic surgery: A case report

“…Esophageal schwannomas are rare, accounting for only 2%–3.4% of all esophageal submucosal tumors (SMT) . Although the optimal treatment for benign esophageal schwannoma is enucleation, it is difficult to diagnose a tumor by preoperative imaging alone.…”